Voice function in patients after extended fronto-lateral laryngectomy

Area of Science:

• Otolaryngology
• Speech and Voice Science
• Oncology

Background:

• Laryngectomy significantly impacts voice function.
• Reconstruction techniques aim to restore voice quality.
• Understanding factors influencing post-laryngectomy voice is crucial.

Purpose of the Study:

• To subjectively and objectively evaluate voice function before and after extended frontolateral laryngectomy with nasal mucochondrial graft reconstruction.
• To analyze phoniatric and acoustic outcomes based on cancer characteristics, wound healing, and phonation mechanisms.
• To correlate objective acoustic measures with subjective voice assessments.

Main Methods:

• Prospective study of 40 patients (T1B and T2 glottic cancer) undergoing laryngectomy and reconstruction.
• Pre- and post-operative ENT, phoniatric (voice recordings, pitch, range, phonation time), and acoustic analyses (jitter, shimmer, harmonic structure).
• Subjective voice evaluation by patients and objective laryngeal mobility assessment.

Main Results:

• Cancer extent (T1B/T2) did not significantly affect post-operative voice quality.
• Maximum phonation time decreased significantly in both T1B and T2 groups.
• Average voice pitch decreased, and acoustic parameters (jitter, shimmer, basic frequency) showed significant changes.
• Voice quality correlated significantly with the phonation mechanism, favoring vocal fold/scar vibration over sphincter phonation.

Conclusions:

• Extended frontolateral laryngectomy with nasal graft reconstruction alters voice parameters, notably reducing phonation time and pitch.
• The mechanism of post-surgical phonation is a key determinant of voice quality, with scar vibration yielding superior outcomes.
• Acoustic and phoniatric analyses provide valuable insights into voice function post-laryngectomy.